BIR UK MRI course

BIR UK MRI COURSE 2014Venue: Events Centre, Stewart House, London

CPD: 24 Credits

4 – 7NOVEMBER

2014

More information available soon at www.bir.org.uk

• Room1Primers for the non-specialistsSessionorganisedbyDrDavid

Wilson,ConsultantInterventional

MSKradiologist,OxfordUniversity

HospitalsNHSTrust

• Room2Radiation protectionSessionorganisedbyMrAndy

Rogers,HeadofRadiationPhysics,

NottinghamUniversityHospitals

NHSTrust

Save the date

• Room1Clinical hybrid imaging in oncologySessionorganisedbyDrGopinathGnanasegaran,ConsultantPhysicianinNuclearMedicine,StThomas’Hospital

• Room2Musculoskeletal imagingSessionorganisedbyDrRichardWakefield,ConsultantinRheumatology,StJames’sUniversityHospital

Essentials for the radiology traineeSessionorganisedbyDrHardiMadani,RadiologyRegistrar,RoyalFreeLondonHospitalandDrAusamiAbbas,CardiothoracicRadiologyPostCCTFellow,UniversityHospitalAlberta

Day 2Day 1

BIR ANNUAL CONGRESS 20154–5 NOVEMBER

LONDON

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Save the date

Day 2

WelcomeandthankyouforcomingtotheBritishInstituteofRadiologyUKMRIcourse2014.

Thisbookletcontainstheabstractsandbiographiesforeachspeaker(wheresupplied)

Thismeetinghasbeenawarded24RCRcategoryICPDcredits(6perday).

TheBIRMRIcourseorganisingcommitteeandtheBIRwishyouaveryenjoyableandeducationalexperience.

Certificate of attendance

Yourcertificateofattendancewillbeemailedtoyouwithinthenexttwoweeksonceyouhavecompletedtheonlineeventsurveyat:

https://www.surveymonkey.com/s/MRIcourse2014

BIR Annual Congress 2015: 4–5 November, London

We are most grateful to

for supporting this conference

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Programme Tuesday 4 November

DAY 1: PHYSICS

09:00 Registration and refreshments

Chair: DrMartinGraves,ConsultantClinicalScientist, CambridgeUniversityHospitalsNHSFoundationTrust

09:40 Welcome and introduction

09:45 Basic physics refresher DrIanCavin,MRIPhysicist,NHSTayside

10:15 Principles of gradient echo imaging MrLukaszPriba,ClinicalScientist, RoyalInfirmaryEdinburgh,NHSLothian

10:45 Principles of fast/turbo spin echo imaging DrMartinGraves,ConsultantClinicalScientist, CambridgeUniversityHospitalsNHSFoundationTrust

11:15 Refreshments

11:45 Principles of diffusion weighted imaging MrLukaszPriba,ClinicalScientist, RoyalInfirmaryEdinburgh,NHSLothian

12:15 Imaging options: what do they mean? DrIanCavin,MRIPhysicist,NHSTayside

12:45 Fat/water imaging DrMartinGraves,ConsultantClinicalScientist, CambridgeUniversityHospitalsNHSFoundationTrust

13:15 Lunch

14:00 Osirix - the top 10 tricks DrJohnCurtis,ConsultantRadiologist,UniversityHospitalAintree

14:30 Paediatric MRI = GA DrOwenArthurs,ConsultantPaediatricRadiologist, GreatOrmondStreetHospital

15:00 Why is my image quality poor? DrGeoffCharles-Edwards,PrincipalClinicalScientist, Guy’s&StThomas’NHSFoundationTrust

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15:30 Incidental findings ProfessorDavidLomas,ProfessorofClinicalMRI, UniversityofCambridge

16:00 Refreshments

16:15 Advanced pulse sequences DrGeoffCharles-Edwards,PrincipalClinicalScientist, Guy’s&StThomas’NHSFoundationTrust

16:45 Question and answer

17:15 Close of day________________________________________________________________________





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Speaker profiles (where supplied)

Dr Owen ArthursConsultant Paediatric Radiologist, Great Ormond Street Hospital

OwenArthursistheClinicalLeadforPaediatricandPerinatalPostMortemImagingatGreatOrmondStreetHospitalinLondon,fundedbyanNIHRClinicianScientistFellowship.HetrainedinpaediatricsandacademicradiologyinCambridge,developingnewpaediatricMRtechniquesforwhichhewonseveralnationalandinternationalprizes.HewasaclinicallecturerinCambridge,ESOR/ESPRfellowinParis,andlatterlyafellowatGreatOrmondStreetHospitalinLondon.Hismaininterestsarenon-accidentalinjuryandpostmortemimaginginchildren,andhehasco-authoredover45peerreviewedpapers,reviewarticlesandbookchapters.

Dr Ian CavinMRI Physicist, NHS Tayside

DrIanCavinisanMRIphysicistwithNHSTaysideprovidingbothclinicalandresearchsupporttoMRIRadiologyaswellasclinicalandacademicresearchersfromtheUniversitiesofDundeeandStAndrews.Priortohiscurrentposition,IanhascarriedoutresearchattheUniversityofNottinghamSirPeterMansfieldMRICentreinvestigatingthebiologicaleffectsofMRImagneticfieldsassociatedwithwholebodyclinical1.5,3and7TeslaMRIscanners.

Dr Geoff Charles-EdwardsPrincipal Clinical Scientist, Guy’s & St Thomas’ NHS Foundation Trust

Aftertrainingasaclinicalphysicist,GeoffCharles-EdwardsobtainedaPhDinmagneticresonancefromtheInstituteofCancerResearch,beforemovingtoGuy’s&StThomas’Hospitalsin2003whereheisnowPrincipalClinicalScientist.HeisalsoaHEFCE-NIHRSeniorClinicalLecturerandanHonorarySeniorLectureratKing’sCollegeLondon.

Dr John CurtisConsultant Radiologist, University Hospital Aintree

DrJohnCurtishasbeenaconsultantradiologistatUniversityHospitalAintreesince1997.Hehasaninterestinchestradiologyandmedicaleducation.HehasorganisedtheAintreeFRCRcoursessince2002andinthelast5yearshashadextensiveexperienceusingOsiriXoncoursesandforteaching.

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Dr Martin GravesConsultant Clinical ScientistCambridge University Hospitals NHS Foundation trust

MartinGravesisaConsultantClinicalScientistatCambridgeUniversityHospitalsNHSTrustwhereheisHeadofMRphysicsandradiologyIT;heisalsoanAffiliatedLecturerwithintheUniversityofCambridgeClinicalSchool.HehasaBScinphysicsandanMScinmedicalelectronicsfromtheUniversityofLondonandaPhDinMRIfromtheUniversityofCambridge.Hehasover30yearsofexperienceworkinginclinicalandresearchMRIinLondonandCambridge.HeisafellowoftheInstituteofPhysicsandEngineeringinMedicineandtheHigherEducationAcademy.HeisactiveonanumberofnationalandinternationalcommitteesincludingtheClinicalImagingBoardandtheISMRMEducationandAnnualMeetingProgrammeCommittees.Hehasauthoredover140journalarticles/bookchaptersaswellastheawardwinningMRItextbookMRI:fromPicturetoProton,PhysicsMCQsforthePart1FRCR,andco-editorofCarotidDisease:theRoleofImaginginDiagnosisandManagement.HeteachesonanumberofMRIcoursesbothnationallyandinternationallyandhasreceivedISMRMOutstandingTeacherawardsin2006and2011.

Professor David LomasProfessor of Clinical MRI, University of Cambridge

DavidJLomasisqualifiedinengineering,medicineandradiologyandhasbeenProfessorofClinicalMRIinCambridgesince2001.HehasworkedcloselywithAddenbrooke’sHepatologyandLivertransplantationservicesoverthelast25yearsandleadstheclinicalMRIservice.HisresearchinterestsincludenoveldevelopmentsinBodyMRIincludingthehepatobiliaryandGItractandhehelpeddevelopMRelastographywithcolleaguesattheMayoClinic.Hehaspublishedover100peerreviewedpapersandlecturedextensivelyintheseareas.PreviouslysecretaryofISMRM,heiscurrentlyChairoftheBIRMRIcommitteeandamemberofthePHEAGNIRgroup.

Mr Lukasz PribaClinical Scientist, Royal Infirmary Edinburgh, NHS Lothian

AftergraduatingwithanMScinmedicalphysicsfromUniversityofAberdeen,LukaszstartedhistrainingasaclinicalscientistinNinewellsHospital,Dundee,NHSTayside.AftersuccessfullycompletinghistraininginMRIanddiagnosticradiology,hejoinedthemedicalphysicsdepartmentinEdinburghwhereheworksnowasaseniorclinicalscientist.Inhiscurrentpost,hefocusesonsupportanddevelopmentofMRIserviceacrossLothian.

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Abstracts (where supplied)

Basic physics refresherDr Ian Cavin

This30minutebasicMRIphysicsrefresherwillrecaptheessentialphysicsneededtogainaworkingknowledgeofMRI.

Principles of gradient echo imagingMr Lukasz Priba

Educationalaim:Abasicunderstandingofimageformationusinggradientechopulsesequence.

Learningoutcomes:Gradientechoisoneofthebasesofmagneticresonanceimaging.Themajoradvantageofagradientechosequenceissignificantreductioninscantime.Toachievethat,smallflipanglesareused,which,inturn,allowveryshortrepetitiontimestobeused.Afterthistalk,delegateswillbefamiliarwithbasicphysicsprinciplesbehindthepulsesequenceandwillgainknowledgeonhowalteringsequenceparameterswillinfluenceresultantimagecontrast.Finally,thispresentationwilldiscussadvantagesanddisadvantagesofusinggradientechopulsesequencesaswellasgivesomeexamplesoffastimagingsequences.

Principles of fast/turbo spin echo imagingDr Martin Graves

Thefastorturbospinecho(FSE/TSE)pulsesequencewasoriginallydevelopedbyHennigetalasamethodtoreduceacquisitiontimesinT2-weightedimaging.Theimplementationisamodificationofamultiple-echospinechosequenceinthateachechoisnowindividuallyphasedencodedandcontributestotherawdata,ork-space,forasingleimage.ForexampleanFSEsequencemaycreate16echoesthroughtheuseof16refocusingpulsesinasinglerepetitionperiod(TR).Sinceeachechoisindividuallyphaseencodedthetimetocompletethefullk-spaceis16timesquicker.Thisdoeshoweverhaveimplicationsforimagecontrast.Sinceeachechoisacquiredatanincreasingtimefromtheinitialexcitationpulsethetimeoftheechothatisencodednearestthecentreofk-spacedictatesthe“effectiveechotime”TEeff,sincethecentreofk-spacehasthegreatestinfluenceonimagecontrast.Furthermore,sincethesignalisdecayingduetoT2relaxationduringtheacquisitionthereisaninevitableimageblurringassociatedwithFSEacquisitions.Theuseofmultiplerefocusingpulsesalsoincreasesthepowerdeposition(SAR)ofthesequence,whichmayrequirecarefuloptimisationofthesequence.

Attheendofthislecturetheparticipantswillbeexpectedto:• UnderstandthebasicprinciplesofFSEimaging.• AppreciatesomeoftheartifactsandlimitationsofFSE.• ExplainhowFSEsequencescanbeoptimised.

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Furtherreading:McRobbieDW,MooreEA,GravesMJandPrinceMR.MRI:fromPicturetoProton2ndEd.CambridgeUniversityPress.ISBN9780521683845

Principles of diffusion weighted imagingMr Lukasz Priba

Educationalaim:Abasicunderstandingofphysicsprinciplesbehindfunctionalimagingbasedonmolecularmotionofwaterinbodytissues.

Learningoutcomes:Diffusionweightedimaging(DWI)hasbeenestablishedasapowerfultoolinneurodiagnostics,mainlyindetectionofacuteischemicstroke.Further,ithasbeenimplementedtostudyneuralfibertractanatomyandbrainconnectivity.Nowadays,useofDWIhasbeenextendedtoimaginginabdomenandpelvisanditisheavilyutilisedinoncologyimagingfordiagnosisandmonitoringtreatmentresponse.Thislecturewillexplainthemoleculardiffusionofwaterinbodytissuesandphysicalprinciplesthatunderlinediffusioncontrastencoding.ThiswillallowthedelegatestounderstandtherelationshipbetweenMRsignalintensityanddiffusion.Withthebasicprinciplesinmind,arangeofmoresophisticatedtechniquesandapplicationswillbereviewed,discussingadvantagesandpotentialissues.

Imaging options: what do they mean?Dr Ian Cavin

Thispresentationwillbesplitintothreesections.Section1willcoverthephysicsprinciples,followedbytheconstructionofabasicpulsesequenceusedinimaginginSection2.Section3willdescribehowthetimingsofradiofrequency(rf)andgradientpulsescanbeusedtogenerateimageswithdifferentcontrast.

Educationalaims:ToprovidedelegateswithausefulandconciseoverviewoftheMRIprinciplessothattheywillbeabletoapplythisknowledgetogainanunderstandingoftheimagingsequencesusedinroutinediagnosticMRI.

Learningoutcomes:Bytheendofthepresentationdelegateswillbeabletoexplainthebasicprinciplesofhow:• AnMRsignalisgeneratedanddetected.• AnMRimageisformed.• Agradientechoimageisformed.• Aspinechoimageisformed.• Aninversionrecoverysequenceisformed.• T1,T2,T2*andprotondensity(PD)imagesaregeneratedwiththeappropriate

selectionofecho(TE)andrepetitiontime(TR).• ApplythebasicprinciplestounderstandtheothertypesofadvanceMRimaging

sequences.

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Fat/water imagingDr Martin Graves

InvivoMRimagesusuallycontainsignalsfromprotonsinbothwaterandfat.Humanfatisstoredastriglycerideswhichareasubgroupoflipidmolecules.Triglyceridescomprisemultiplegroupsofprotons(CH3,CH2,CH=CHetc)withthenuclearshieldingeffectresultinginarangeofchemicalshifts.Themostabundantresonancecomesfromthemethylene(CH2)groups,whichprecessapproximately3.4ppmlowerthanwater.Intermsofrelaxationtimes,fathastheshortestT1,approximately270msat1.5T,ofanybodytissue.Inthislecturewewillconsidertechniquesthatcanallowustoeithersuppressthesignalfromfatorprovidequalitativeorquantitativemeasurementsoffatcontentinordertoaiddiagnosis.Fatsuppressiontechniquescaneitherbeusedtoimprovethecontrastinanimagebyremovingthehighsignalfromlipids,ortoreducetheartefactsthatarisefromthechemicalshiftbetweenwaterandfat.Fatsensitivetechniquescanalsobeusedtohelpcharacterisefat-containinglesionsandprovidequantitativemeasurementsoforganfatsuchasintheliver.

Attheendofthislecturetheparticipantswillbeexpectedto:• Describetheeffectsofthechemicalshiftbetweenwaterandfat.• Comparevariousmethodsoffatsuppression.• Explaintheprinciplesandapplicationsofchemical-shift-basedimaging

techniques.

Furtherreading:McRobbieDW,MooreEA,GravesMJandPrinceMR.MRI:fromPicturetoProton2ndEd.CambridgeUniversityPress.ISBN9780521683845HorgerW.FatSuppressionintheAbdomen.SiemensMagnetomFlash2007:3;114-119

OsiriX - the top 10 tricksDr John Curtis

OsiriXisafreesourcesoftwareusingApplecomputersandisnowwidelyusedbyradiologiststodisplayDICOMimagesforreporting,teachingandexamining.TherearenumerousactionspossiblewithOsiriXbutinthislecturethetoptentrickswillbecoveredthatwillgetthenoviceupandrunningandtheexperienceduserabletoperformadvancedactionstoaugmentteachingandarchiving.

Paediatric MRI = GADr Owen Arthurs

ThispresentationwillfocusonthecurrentchallengesinperformingMRIexaminationsinsmallchildren.Toachievediagnosticimagesthisoftenneedsthemtoliestilltoreducepatientmotion.Therefore,toobtainhigh-qualityimages,paediatricMRIisfrequentlycarriedoutundersedationorgeneralanaesthesia,butthisisnotwithoutriskandexpense.ThispresentationwillfocusonthecurrentadvantagesanddisadvantageofsedationandanaesthesiaforpaediatricMRI,thecurrentalternativesthatareavailable(includingneonatalcomfortingtechniques,sleepmanipulation,andappropriateadaptationofthephysicalenvironment),aswellasgeneralissuesinpaediatricMRIsuchasRF

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heating.Thereisanincreasingunderstandingonwhatcanbeachievedwithsub-anaestheticdosesoftraditionalanaestheticdrugs,aswellaswhatcanbeachievedwithoutaccesstoanaestheticdrugsatall.Therisk–benefitanalysismustultimatelybetakenonapatient-by-patientbasis,andtothisendshoulddetermineserviceprovisionandtrainingrequirements.ThechoiceofapproachtoappropriatepaediatricMRIismultifactorial,withlimitedscientificevidenceformanyofthecurrentapproaches.

Educationalaims:TohighlightthelimitationsofthedifferentoptionsavailableforpaediatricMRI.

Learningoutcomes:ToappreciatethechallengesfacedindeliveringpaediatricMRIexaminationsandto“broadenthemind”withpossiblesolutions.

References• ArthursOJ,SuryM.AnaesthesiaorsedationforpediatricMRI:advantagesand

disadvantages.CurrentOpinioninAnesthesiology(2013)26:489-494• ArthursOJ,EdwardsAD,AustinTA,GravesMJ,LomasDJ.Thechallengesofneonatal

magneticresonanceimaging.PediatricRadiology(2012)42:1183–1194• EdwardsAD,ArthursOJ.PaediatricMRimagingundersedation:isitnecessary?What

istheevidenceforthealternatives?PediatricRadiology(2011)41:1353–1364• SuryMRJ,HarkerH,BegentJetal.Themanagementofinfantsandchildrenfor

painlessimaging.ClinRadiol(2005)60:731–741

Why is my image quality poor?Dr Geoff Charles-Edwards

Educationalaims:TohighlightthevariousissuesrelatingtoMRimagequality.

Learningoutcomes:AnunderstandingofthereasonsforapoorqualityMRimage.AlthoughitistypicallystraightforwardtoidentifythatthequalityofanMRimageispoor,thereasonsforthisaresometimeslessobviousandnotwellunderstood.ThistalkwillcoverissuessuchasSNR,acquiredversusreconstructedspatialresolution,distortions,T2-blurring,andMRartefactsshowingexamplesandhighlightingapproachestoresolvecommonissues.

Incidental findingsProfessor David Lomas

Thedetectionof“incidental”findingsbydiagnostictestsisanincreasinglycomplexproblem.Thisappliesnotjusttoimagingbuttootherdiagnostictestsandinparticulargenesequencing.Theproblemiscompoundedbyusingdiagnostictestsdesignedforsymptomaticpatientstostudy“healthy”individualsbyeither“screening”proceduresorasapartofresearchstudies.Therearenowmultiplelargepopulationbasedstudiesbeingundertakentolinkthegeneticsofanindividualtotheirphenotypeanddiseaserisk,severalofwhichinvolveimaging-usuallywithMRI(egUKBiobank).

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Incidentalfindingsmaybecategorisedaccordingtotheirsignificanceandtheincidencevarieswidelydependingonthenatureofthetestandthepopulation.Examplesofsignificantfindingsincludeunexpectedasymptomaticbrain,lung,renalorcoloncancers,gallstonesinthecommonbileduct,andacerebralAVM.Recentstudiessuggestincidentalfindingsinasmanyas20%ofstudiesalthough“significant”findingsthatmayadverselyaffecthealthareusuallylessthan5%.

InresearchstudiesthedetectionandmanagementofincidentalfindingsshouldnowbeexplicitlyaddressedduringtheEthicalReviewprocessandparticipantsshouldbeinformedoftherisksandconsequencesofsuchfindings.Thesemightincludetheanxiety,costandrisksrelatedtofurtherinvestigation(eg,brainorliverbiopsy)toachieveadefinitivediagnosis.Inmanycasestherisksoffalsenegativeandfalsepositivesarepoorlyunderstoodandmaynotbeknown.Unexpectedcomplicationsofanincidentalfindingsuchasrefusalforlifeinsuranceoramortgageapplicationareoftennotconsideredorappreciatedinadvance.

RecentpublicconsultationstudiesbytheWellcomeTrusthavemadeclearthatthegeneralpopulationarelargelyunawareoftheseissuesandhaveasimplisticviewofbenefitrelatedtodetectinganddiagnosinganunexpecteddiseaseprocess.ThislackofunderstandingandpubliceducationhasrecentlybeenhighlightedbytherecentCOMAREreportfirmlyadvocatingagainstself-referralCTandotherimagingscreeningservicesbeingofferedbytheprivatesector.

InthepastmanyMRIsiteswouldusetheirstaffandstudentsasvolunteersforMRIresearchstudieswithonlyminimalunderstandingandoversightoftheseissues.ThisisnolongerconsideredacceptableandMRIsitesnowrequireethicalapprovalandwritteninformedconsentforvolunteerstudies,eventotestoutnewsequencevariations,protocolsornewapplications.Informationhastobegiventotheparticipantoutliningtherisksandmanagementofincidentalfindings.Thereisnotyetcompleteconsensusontheseissuesbutthereislargelyagreementthatforparticipantsinscreeningandresearchstudiesthereshouldbe“nosurprises”.

Advanced pulse sequencesDr Geoff Charles-Edwards

Educationalaims:TodescribethebasicprinciplesandkeybenefitsofsomeofthemoreadvancedpulsesequencesavailableonclinicalMRIscanners.

Learningoutcomes:Anunderstandingoftheaimsandlimitationsofsomeofthemoreadvancedpulsesequences.

ThereisacontinuingexpansionofpulsesequencesandtechniquesavailableonclinicalMRIsystems.Thistalkwillintroducethebasicconceptsofsomeoftheseandhighlightareaswheretheyappearstohavesignificantutility.TopicswillincludePROPELLER/BLADE/multi-vaneforreducedmotionartefact,SPACE/CUBE/VISTAforspin-echobased3Dacquisitions,temporalsharingfordynamiccontrast-enhancedMRI,susceptibility-weightedimagingforenhancedsensitivitytomicrobleedsandnewmetalartefactreductionsequences.

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Programme Wednesday 5 November

DAY 2: BODY - GI/HPB


Chair: ProfessorDavidLomas,ProfessorofClinicalMRI, UniversityofCambridge

09:00 Lecture A - a scientific lecture given by the ‘physicist of the day’ to cover the physics aspects of the subsequent lectures DrGeoffCharles-Edwards,PrincipalClinicalScientist, Guy’s&StThomas’NHSFoundationTrust

09:30 Lecture B - Diffuse liver ProfessorDavidLomas,ProfessorofClinicalMRI, UniversityofCambridge

10:00 Lecture C - Focal liver DrSofiaGourtsoyianni,ConsultantRadiologist, Guy’sandStThomas’NHSFoundationTrust

10:30 Lecture D - MRCP/pancreas DrHelenBungay,ConsultantGastrointestinalRadiologist, OxfordUniversityHospitalsNHSTrust

11:00 Refreshments

11:30 Workshop session 1 - topics A&B and C&D

12:15 Workshop session 2 - topics C&D and A&B

13:00 Lunch

14:00 Lecture E - Upper GI DrAngelaRiddell,ConsultantDiagnosticRadiologist, TheRoyalMarsdenHospital

14:30 Lecture F - Lower GI DrSofiaGourtsoyianni,ConsultantRadiologist, Guy’sandStThomas’NHSFoundationTrust

15:00 Workshop session 3 - topics E&F

15:45 Refreshments

16:15 Panel discussion reviewing complex cases

17:00 Close of day

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Dr Geoff Charles-EdwardsPrincipal Clinical Scientist, Guy’s & St Thomas’ NHS Foundation Trust

Seepage4

Professor David LomasProfessor of Clinical MRI, University of Cambridge

Seepage5

Dr Sofia GourtsoyianniConsultant Radiologist, Guy’s and St Thomas’ NHS Foundation Trust

April2012-March2013-ClinicalResearchFellow,DivisionofImagingSciences,King’sCollegeLondon,Guy’sandStThomas’NHSFoundationTrust,London,UK

February2011-February2012-LocumConsultantRadiologist,KonstantopouleionGeneralHospital,Athens,Greece

January2010-January2011-ResearchFellowinCTApplications,DepartmentofComputedTomography,BethIsraelDeaconessMedicalCenter,HarvardMedicalSchool,Boston,USA

January2006-November2009-ResidentinRadiology,DepartmentofRadiology,UniversityHospitalofHeraklion,Crete,Greece

May2004-November2005-InstituteofClinicalRadiology,LudwigMaximilianUniversity,CampusInnenstadtandCampusGrosshadern,Munich,Germany

Dr Helen BungayConsultant Gastrointestinal Radiologist, Oxford University Hospitals NHS Trust

Helenisaconsultantgastrointestinalradiologist,specialisinginhepatobiliaryandpancreaticimaging,attheOxfordUniversityHospitalsNHSTrust.HavingstudiedatStJohn’sCollege,Cambridge,andGreenCollege,Oxford,shedidherradiologytraininginOxford.Helenis,indeed,bigsistertoPeterBungay,ConsultantRadiologist,Derby!Butalsomumtotwogorgeousdaughters.ShehasspokenatRSNA,BSGAR,RCRandBIRstudydays,butalsoenjoysfacepaintingatschoolfetes.Sheisveryhappytodiscussinterestingcaseswithpeoplefromdifferenthospitals,andwishalittlemoreofthatcooperationwerepossibleinthetimestrappedNHS.

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Dr Angela RiddellConsultant Diagnostic Radiologist, The Royal Marsden Hospital

DrAngelaRiddellworksasaconsultantdiagnosticradiologistattheRoyalMarsdenHospital.HerworkisinoncologyimagingwithspecialistinterestsinupperGIandhepatobiliarycancer.SheinitiallytrainedinradiologyinOxford&undertookanabdominalimagingFellowshipinTorontobeforeundertakingaradiologyresearchpostattheRoyalMarsdenHospital.ShewasawardedanMDin2007forherresearchdevelopinganMRItechniqueforassessingoperabilityinoesophago-gastriccancer.SheiscurrentlytheleadinvestigatorforaUKmulti-centretrialinvestigatingthetechnique.SheistheleadradiologyrepresentativeontheLondonCancerAllianceforupperGI&hepatobiliarycancers.


Lecture B - Diffuse liverProfessor David Lomas

MRIisofvalueinthedetectionand,increasingly,quantificationofarangeofdiffuseliverdiseases.

Hepatic steatosis or “fatty liver”

Theepidemicofobesityaffectingthewesternworldhasledtotherecognitionthat“fattyliver”isnolongera“normalvariant”butamarkerofpotentiallyimportantdisease,inparticularnon-alcoholicsteato-hepatitis(NASH)whichisexpectedtobecomethemajorcauseofliverfibrosis/cirrhosisandhepatocellularcarcinomainthenextdecade.Regionalvariationofhepaticfat(focaldepositionandsparing)isalsoanincreasingdiagnosticprobleminradiology.MRIprovidesbothconfidentdiagnosisandquantificationofglobalandregionalhepaticsteatosisthroughbothinandoutofphaseimagingand3pointDixontechniques.Inthefuturethesewillbewidelyavailableandarelikelytousefulforthemonitoringofhepaticsteatosisasnewtherapiesemerge.

Hepatic iron – haemochromatosis/haemosiderosis

ItwasrecognisedveryearlyinthedevelopmentofMRIthataccumulationofironintheliverresultsinT2andT2*shortening–reducingtheliversignalrelativetoothertissues.MorerecentlyreliablemethodstoaccuratelyevaluateT2valuesandcorrelatethesewithhepaticironconcentrationhavebeendeveloped.TheseincludeacommercialFDAapprovedofferingdevelopedinAustraliaaswellasseveral“DIY”methodspublishedintheliterature.Theorganpatternofirondepositionmayalsousefultohelpcharacterisetheunderlyingaetiology.

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Liver fibrosis

Traditionally,imagingtestshavebeenrelativelyinsensitivetomildandmoderateliverfibrosisandonlyofrealvalueinestablishedcirrhosiswhenmorphologicalchangeshavedeveloped.Increasinglythisviewisbeingchallengedbynewerfunctionalimagingapproacheswhichincludeelastography(usingbothMRIandUS)andmeasurementsoftheextra-cellularmatrixusingT1methods.Whilstthesearestillbeingvalidated,severalarenowavailablecommercially.Thesetechniquesarealreadyreducingthenumberofdiagnosticliverbiopsiesperformedforsuspectedliverdisease.

Lecture C - Focal liverDr Sofia Gourtsoyianni

Mostcommonlyencounteredfocalliverlesionsinnon-cirrhoticpatientsandtheirtypicalMRIcharacteristicswillbereviewed.DifferentavailableMRIcontrastmechanismsincludinghepatocytespecificcontrastagentsandDWIacquisitionprotocols(optimalbvalues,optimalsequences)willbediscussed.

FocuswillbeplacedonhowDWIandhepatocytespecificcontrastagentscanaidincharacterisationoffocalliverlesionsanddifferentiationbetweenbenignandmalignantlesions(mainlylivermetastases).

Lecture D - MRCP/pancreasDr Helen Bungay

Educationalaims:ThissessionisaimedatconsultantradiologistswhoreportMRCP/MRIpancreas,butdonotholdaspecialistHPBpost,andradiologytrainees.

Thelecture,andtheaccompanyingworkshops,willdiscuss:MRCP:including:• Normalanatomyandvariantsofclinicalimportance(especiallybiliaryvariants

relevanttocholecystectomy);• Artefactsandmimicks;• pathology:calculi;tumour;primarysclerosingcholangitis.

MRIofthepancreas:including:• Pancreatitis;cysticlesions;IgG4relateddisease.

ThesessionwillincludewhentouseMRI,utilityofdifferentsequences,tipsontechniqueandcommonpitfalls,aswellasanoverviewofcommonandimportantpathologies.

Learningoutcomes:Delegatesshouldknowtherelevantanatomyandsequences,understandwhentochooseMRItoimagecertaingroupsofpatients,applytechniquemodificationsforoptimalimages,analysetheimagesinlightofthepossibleartefacts,andsynthesiseareport,knowinglikelycommondiagnoses.

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Lecture E - Upper GIDr Angela Riddell

WithadvancesinsurfacecoiltechnologyandthedevelopmentoffastersequencesitisnowpossibletoachievegoodqualityimagingoftheupperGItract.ThereisanemergingroleforMRIinbothmorphologicalandfunctionalimagingoftheupperGItract.

ThelecturewilldescribehowfunctionalMRIhasbeenevaluatedasanalternativetovideofluoroscopyfortheassessmentofmotilitydisorderswithintheoesophagusforseveralyears.Smallgroupstudieshaveshownthatitshowspotentialtodiagnosemotilitydisorders,suchasgastro-oesophagealrefluxandachalasia.

Researchstudieshavealsodemonstratedtheutilityofthetechniquetolocallystageoesophagogastriccancerandtoassessresponsefollowingneoadjuvanttherapy.Thelecturewillofferguidanceonsequenceselectionandoptimisationtoachievediagnosticqualityimagesinthischallengingarea;highlightthestrengthsandweaknessesofthetechniqueanddemonstratewherethetechniquecouldpotentiallyfitintothestagingalgorithmforpatientswithoesophago-gastriccancer.Itwillalsoshowhowtheintroductionofdiffusionweightedimaginghasenabledthetechniquetobeusedinresponseassessmentfollowingneoadjuvantchemotherapyandchemoradiotherapy.Itwillalsodescribehowthetechniqueisbeingutilisedforradiotherapyplanning.

Lecture F - Lower GIDr Sofia Gourtsoyianni

Pre-operativeMRIoftherectum,usingmainlyhighresolutionT2weightedsequences,hasgainedsignificantaccreditation,especiallyaftertheintroductionoftotalmesorectalexcision(TME)surgeryandneoadjuvanttherapyinthetreatmentregimenofrectalcancer.MRimagingissofartheonlymethodthatcanpreoperativelyidentifypatientsmostlikelytobenefitfromneoadjuvanttherapyaswellasdemonstratehighriskpatientsforlocalrecurrence/metastaticdisease.

StateoftheartMRimagingprotocolstailoredtoallowradiologiststoobtainallnecessaryinformationforappropriatetreatmentdecisionmaking,willbedescribed.MRsignalchangesencounteredinpelvicstructures/tissuesinvolvedbyprimaryrectalcanceratbaselinestagingaswellasaftercompletionofneoadjuvanttreatmentwillbeillustrated.Influenceofimagingfindingsoninitialtherapeuticapproachwillbediscussed.

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Programme Thursday 6 November

DAY 3: NEURO - BRAIN


Chair: DrMarkRadon,ConsultantNeuroradiologist,TheWaltonCentre

09:00 Lecture A - a scientific lecture to cover the physics aspects of the subsequent lectures DrJonathanAshmore,MRIPhysicist,King’sCollegeHospital

09:30 Lecture B - Demyelination and inflammation DrBrynmorJones,ConsultantNeuroradiologist, ImperialCollegeLondon

10:00 Lecture C - Stroke and mimics DrTufailPatankar,ConsultantNeuroradiologist, LeedsGeneralInfirmary

10:30 Lecture D - Epilepsy DrIanCraven,ConsultantNeuroradiologist, SheffieldTeachingHospitalsNHSFoundationTrust

11:00 Refreshments



13:00 Lunch

14:00 Lecture E - Tumours DrMarkRadon,ConsultantNeuroradiologist,TheWaltonCentre

14:30 Lecture F - Congenital brain and spine abnormalities in children DrStavrosStivaros,HeadofPaediatricNeuroradiology, RoyalManchesterChildren’sHospitaland NationalInstituteforHealthResearch(NIHR)ClinicianScientist, UniversityofManchester


15:45 Refreshments


17:00 Close of day

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Dr Jonathan AshmoreMRI Physicist, King’s College Hospital

JonathanAshmoreisanMRIphysicistspecialisinginneuroimagingatKing’sCollegeHospital,London.HedidhisclinicalscientisttrainingatUniversityCollegeLondonHospitalandtheNationalHospitalforNeurologyandNeurosurgery,QueensSquare,London.HisareasofinterestincludeadvancedMRItechniquesforbraintumourimagingandpre-surgicalplanning.

Dr Ian CravenConsultant NeuroradiologistSheffield Teaching Hospitals NHS Foundation Trust

DrCravenisaConsultantNeuroradiologistwithasub-specialtyinterestinpaediatricandneonatalimagingatLeedsGeneralInfirmary.HeisanEducationalLeadforradiologyintheLeedsTeachingHospitalTrustandSpecialistInterestLeadforNeuroradiology.

HeiscurrentlyundertakingaPhDatSheffieldUniversityinMRbrainimaginginyoungadultsandchildren.Duringhisfellowship,heundertookseveralresearchprojectsinepilepsyimagingat3.0Tandhasrecentlysetupa3.0TserviceforimagingrefractoryfocalepilepsyinLeeds.

Dr Brynmor JonesConsultant Neuroradiologist, Imperial College London

2004-2008:DiagnosticradiologytrainingatHammersmithHospitalNHSTrust.2008-2010:PanLondonDiagnosticNeuroradiologyFellowship.2010–present:ConsultantDiagnosticNeuroradiologist,ImperialCollegeHealthcareNHSTrustwithaninterestinpaediatricneuroimaging.

Dr Tufail PatankarConsultant Neuroradiologist, Leeds General Infirmary

DrPatankartrainedinManchesterindiagnosticandinterventionalneuroradiologyandgotPhDinmedicinefromUniversityofManchestermainlyinMRperfusioninbraintumours.HehasbeenaconsultantneuroradiologistintheUKforthelast9years.HestartedtheinterventionalserviceinPrestonandmovedtoLeeds4yearsago.

DrPatankarhasexpertiseinendovasculartreatmentofneurovasculardiseasesespeciallyinbrainaneurysmsandemergingtechnologiesinflowdivertorsandflowdisruptors.

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Hehasaspecialinterestinimaginginstrokeparticularlyinadvancedimagingofstrokeanditsroleintreatmentofstroke.Hehasover100publicationsinpeer-reviewedjournalsandhasbeeninvolvedwithvariousresearchprojectsinbraintumourandbiomarkerimagingandtreatmentofneurovasculardiseases(mainlybrainaneurysmsandstroke).

Hehasbeeninvolvedwithteachingandtrainingmedicalstudents,radiologytraineesandneurologyandneurosurgicaltraineesatUniversityofLeedsandUniversityofManchesterandhasbeeninvolvedwithsupervisingPhD,MDandMScstudentsatUniversityofManchesterandLeeds.

HehasbeenaproctorforwebtreatmentofbrainaneurysmsandbeentrainingneurointerventionsistinUKandEuropeandinaddition,havetrained,supportedandassistedcomplexneurointerventionalcasesinanumberofUKandEuropeancentres.

HeisanAssociateEditorforBJRandmemberofthetrainingandstandardssubcommitteeandacademicsubcommitteeandresearchsubcommitteeofBSNRandreviewerfornumberofnationalandinternationaljournals.

Dr Mark RadonConsultant Neuroradiologist, The Walton Centre

DrRadonqualifiedfromtheUniversityofCambridgemedicalschool,andsubsequentlytrainedinradiologyinSheffield.HetookafellowshipindiagnosticneuroradiologyattheNationalHospitalforNeurologyandNeurosurgeryinLondonandnowworksasaconsultantneuroradiologistatTheWaltonCentreinLiverpool.

Dr Stavros StivarosHead of Paediatric Neuroradiology, Royal Manchester Children’s Hospital and National Institute for Health Research (NIHR) Clinician Scientist, University of Manchester

StavrosStivarosisHeadofPaediatricNeuroradiologyattheRoyalManchesterChildren’sHospital,oneofthelargestspecialistchildren’shospitalsinEuropeandisalsoaNationalInstituteforHealthResearch(NIHR)ClinicianScientistattheUniversityofManchester.Hespecialisesinpaediatricneuroradiologywithaspecialinterestinimaginghydrocephalusandtheimagingofbloodflowandcerebrospinalfluidthroughouttheheadandspineandleadsthepaediatricmulti-parametricimagingresearchgroupwhichcombinesanatomical,physiologicalandfunctionalimaginganalysisinspecificdiseasegroupsincludingneurofibromatosis,autism,epilepsyandchildren’sbraintumours.

DrStivarosholdsadegreeinmedicalphysicsfromUniversityCollegeLondonaswellasamedicaldegreefromtheUniversityofManchesterfromwhereheobtainedhisjointcomputerscience/medicalimagingPhD.Hefrequentlyprovidesevidenceandreportstothecourtandcoroneronissuesrelatedtobrainimaginginchildren.

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Lecture A - a scientific lecture to cover the physics aspects of the subsequent lecturesDr Jonathan Ashmore

ThereareanumberofadvancedMRItechniqueswhichcansignificantlyaidinneuroradiologicaldiagnosisandtreatmentplanning.Theseinclude:• Magneticresonancespectroscopy(MRS)• Diffusionweighted(andtensor)imaging• Dynamicsusceptibilitycontrast(DSC)perfusionimaging• Arterialspinlabelling(ASL)perfusionimaging• Susceptibilityweightedimaging(SWI)• Volumetricimaging(includingCUBE/SPACE/VISTA)

Manyofthesetechniqueshave,however,hadlimiteduptakeintoroutineclinicalusepotentiallyduetodifficultiesintheirimplementationandinterpretation.

MRSmeasurestheprotonNMRsignalforhydrogenatomsattachedtovariousmetabolitesratherthanthoseattachedtothewatermolecule.Theseprotonsresonateatslightlydifferentfrequenciestothoseinthewatermoleculeallowingthemtobedisplayedina“spectra”ofmetabolitesratherthananimage.Theirclinicalapplicationsincludebraintumourdiagnosisandtheidentificationexoticmetabolicspeciesinpaediatricneurologicaldisorders.

DWIweightstheimagetothediffusiverandommotionofwatermoleculesfromwhichmapsoftheapparentdiffusioncoefficient(averagediffusionalongeachdirection)andthefractionalanisotropy(therelativerestrictionofdiffusionalongonedirectioncomparedtotheother)canbecreated.

DSCandASLaretechniqueswhichmeasureperfusionthroughendogenousandexogenousbasedcontrastmethodsrespectively.TheuseofgadoliniuminDSCresultsinincreasedSNRandthereforeshorterimagingtimesbutwiththeassociatedrisksofinjectinggadolinium.InASLspinsarelabelledwithinmajorfeedingarteriesandproducesuppressionofsignalfromthetissueintowhichtheyperfuse.Thesemethodshavefounduseindiagnosisofoncologicalandvascularpathologies.

SWIisaT2*basedimagesequencewhichutilisesthephaseshiftassociatedwithsusceptibilitydifferencesintissuetoenhancethecontrastintheresultantT2*weightedimage.Itsmajoruseistoenhancetheidentificationofbleed.

ThevolumetricfastspinechosequencesCUBE(GE),SPACE(Siemens),VISTA(Philips)utilizeastandard3Dfastspinechotechniquebutwithamodifiedrefocusingpulsetoallowfortheuseoflongechotrains.ThesemethodsreplacestandardT1W,FLAIRandT2Wimagingforcertainapplicationssuchassurgicalplanningwheretrue3Dimagingisbeneficial.

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Lecture B - Demyelination and inflammationDr Brynmor Jones

BothconventionalandadvancedMRItechniquesgiveavaluableinsightintoadiverseandoftendevastatinggroupofdisordersaffectingthecentralnervoussystem(CNS).ThistalkwillconcentrateonthecommonCNSdemyelinatingdisorderslookingatconventionalMRIimagingfeatureswhichincombinationwithclinicalfindingswillhelptoprovideanappropriatedifferentialdiagnosis.Particularattentionwillbegiventoclinicallyisolatedsyndromes(CIS)andmultiplesclerosis(MS)withdiscussionofthespecificityofimagingfindingsrequiredfordiagnosis.Otherprimarydemyelinatingpathologiessuchasneuromyelitisoptica(NMO)willbecoveredemphasisingthedifferentialdiagnosisoflongintramedullaryspinalcordlesions.

DiseasemodifyingtherapiesarenowfrequentlyemployedinMS.JCvirusrelatedprogressivemultifocalleucoencephalophyisadisorderwhichwaspreviouslyonlyseeninseverelyimmunocompromisedHIVpatients.Itis,however,ararebutwellrecognisedcomplicationofsomeofthesediseasemodifyingtreatments.

Wewillreviewsomeofthesecondarydemyelinatingdisorderssuchasacutedisseminatedencephalomyelitis(ADEM)andbrieflydiscussotherCNSinflammatoryconditionssuchasneurosarcoid,Behcet’sandsystemlupuserythromatosis(SLE).

Lecture C - Stroke and mimicsDr Tufail Patankar

TheinterestinMRIasatoolforacutestrokemanagementliesnotonlyinthecapabilityofthistechniquetodetectearlyischemiclesionswithhighsensitivity,butalsointhebreadthofthecerebrovascularpathologyrevealedbysuchimaging.MultimodalMRIcandelineatethepresence,size,location,extentandeffectsofacutebrainischemia,identifythehypoperfusedtissuethatisatriskofinfarction,andshowadditionalfeaturesofthecerebrovascularpathology.MRIcanalsodetectorexcludehemorrhagewithaccuracycomparabletoCT.TheadditionaldiagnosticinformationobtainedwithMRIcouldresultinimprovementsinpatientoutcomesandcost-effectiveness.

ThepresentationwillcovertypicalacutestrokeMRIimagingandthebenefitsofvariousMRsequencesandmagneticresonanceangiographyandperfusion-weightedwhichhastransformedthediagnosisofischemicstrokeimaging.ItaimstodiscussMRappearancesofstroke,thedifficultiesthatcanbeencounteredbytheradiologistsandthevariousotherpathologiesthatcanmimicstroke.

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Lecture D - EpilepsyDr Ian Craven

Imagingpatientswithepilepsycanbeacontentioustopicasoftenwearegivenlimitedinformationyetexpectedtoexcludeamultitudeofpathologies.Inatimepressuredclinicalenvironment,theutilisationofmultiplesequencesisundesirable.Thissessionwillcoverhowtoidentifypatientsthatrequirein-depthexaminationusingdedicatedepilepsyprotocols.Thecommonpathologieswillbediscussedindetailwithmultipleexamplesillustratingwhycertainsequencesaresoimportant.Therareaetiologieswillalsobecovered,allowingtheaudiencetoseeexamplesthattheymaynothavecomeacrossintheirownpractice.Advancedimagingtechniqueswillbediscussedtogivetheaudienceinsightintowhatcanbeachievedandwhatmaybecomeroutinepracticeinthefuture.Thecasesprovidedfortheworkshopwillhelpconsolidatethelecturematerialandalsoallowinformeddiscussionofeverydayproblemsencounteredinclinicalpractice.

Lecture E - TumoursDr Mark Radon

MRIisthecoremodalityforthediagnosisandfollow-upofbraintumours.Thislecturereviewsthemostimportanttypesofprimarybraintumourandtheirimagingcharacteristicsandfeaturesthatdistinguishthemfrommetastatictumours.

Theimportanceofanatomicallocalisationfordifferentialdiagnosisandsurgicalplanningishighlighted,withemphasisonthedifferencesbetweenintra-axialandextra-axialtumours,andbetweensupra-andinfra-tentorialregions.Thefeaturesofavariouslow-andhigh-gradetumoursarecompared,andindicationsforadvancedMRItechniquesdiscussed.Treatmenteffectsarealsoillustrated.Commonpitfallsinbothdiagnosisandfollow-uparehighlighted,andtheindicationsfortheuseoftechniquessuchasMRspectroscopyandperfusionarereviewed.

Thistalkaimstoillustratetheapplicationoftheseprincipleswithseveralcases,andhighlightthefindingswhichassistindiagnosisandfollow-up.

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Programme Friday 7 November

DAY 4: MSK - FUNDAMENTALS


Chair: DrDavidWilson,ConsultantInterventionalMSKRadiologist, OxfordUniversityHospitalsNHSTrust

09:00 Lecture A - a scientific lecture to cover the physics aspects of the subsequent lectures DrPeterWright,PrincipalMRIPhysicist, SheffieldTeachingHospitalsNHSFoundationTrust

09:30 Lecture B - Cartilage DrBernhardTins,ConsultantMusculoskeletalRadiologist, TheRobertJonesandAgnesHuntOrthopaedicandDistrictHospital

10:00 Lecture C - Bone DrDavidWilson,ConsultantInterventionalMSKRadiologist, OxfordUniversityHospitalsNHSTrust

10:30 Lecture D - Soft tissue tumours DrGeoffHide,ConsultantMusculoskeletalRadiologist, FreemanHospital

11:00 Refreshments



13:00 Lunch

Chair: DrSarahBurnett,ConsultantMusculoskeletalRadiologist, KingEdwardVIIHospital

14:00 Lecture E - Spine DrWinstonRennie,ConsultantMusculoskeletalRadiologistand HonorarySeniorLecturer,UniversityHospitalsofLeicesterNHSTrust

14:30 Lecture F - Rib lesions DrSarahBurnett,ConsultantMusculoskeletalRadiologist, KingEdwardVIIHospital


15:45 Refreshments


17:00 Close of event

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Speaker profiles (where supplied)Dr Sarah BurnettConsultant Musculoskeletal Radiologist, King Edward VII Hospital

SarahBurnettisaConsultantMusculoskeletalRadiologist,formerlyatStMary’sandtheRoyalNationalOrthopaedicHospital,shehasbeeninindependentpracticesince2001.Shequalifiedinmedicinein1985,andstartedherradiologytrainingatStBartholomew’sin1998,becomingaconsultantin1993.SheistheClinicalLeadforQualityat4WaysHealthcare,andhasvastexperienceofteleradiologyandaudit.Shealsohasalargemedicolegalpractice.

Dr Geoff HideConsultant Musculoskeletal Radiologist, Freeman Hospital

DrHidequalifiedinmedicinefromtheUniversityofNewcastleuponTynein1990andwasappointedasaconsultantradiologistatNewcastleUponTyneHospitalsin2002,withaspecialinterestinmusculoskeletalimaging.Heistheleadradiologistfortheboneandsofttissuetumourservice.HeisamemberoftheInternationalSkeletalSociety,currentlythetreasureroftheBritishSocietyofSkeletalRadiologistsandhasactedasanadvisortoNICEandtheDepartmentofHealth.

Dr Winston RennieConsultant Musculoskeletal Radiologist and Honorary Senior Lecturer, University Hospitals of Leicester NHS Trust

DrRennieisaConsultantMusculoskeletalandTraumaInterventionalRadiologistwithanacademicinterestattheLeicesterRoyalInfirmary.HehassetuppioneeringpalliativeinterventionalprocedureslikespinaltumourcoablationandcementoplastyinLeicester.HewasInvolvedincollaborativeresearchprojectswithLoughboroughUniversityandisasupervisoroftwoPhDfellowsinBiomechanicsandinPhysicalsciences.Hehasaspecialinterestinthespineandspinalintervention,havingsetuptheRFKyphoplastyserviceinLeicesterforspinalfractureswithstandardisedQoLoutcomemeasures.

HisspecialdiagnosticinterestisspineMRimaginginSpA,havingcaughtthebugworkingasamusculoskeletalradiologyfellow,intheprestigiousCanadianUniversityofAlbertawithProfessorsWMaksymowychandRLambert.HehasprovidedadvicetotheNationalAnkylosingSpondylitisSociety,withguidanceonsettingupservicesintheUnitedKingdom.HehasdevelopedstandardisedprotocolsinSpAMRimagingandaminvitedinternationalfacultyteachingbothNationallyandInternationallyonhandsonMRIinSpAcoursesforrheumatologistandradiologists.HewasrecentlyappointedontotheNICEGuidelinesDevelopmentGroupforSpAintheUK.

Heisareviewerforpeerreviewedjournalsinawiderangeofspecialitiesrangingfromorthopaedics,trauma,sportsmedicine,RheumatologyandradiologybasedintheUK,NorthAmericaandEurope.Heattempttostimulateaninterestinresearch,highqualityreportingandjournalpublicationsamongsthistrainees.

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HehasbeeninvitedtocontributetoanSpAthinktankheldatPortcullisHouse(HouseofCommons).Inthelittletimehehastospare,heenjoysplayingtheguitar(verybadly)tothewomenwhocaretolisten(hiswifeandyoungdaughters!).

Dr Bernhard TinsConsultant Musculoskeletal Radiologist, The Robert Jones and Agnes Hunt Orthopaedic and District Hospital

DrTinsstudiedphysicsandmedicineinMünster,Germanyandinitiallywantedtobecomeascientist.Howeverhechangedhismindandbeganworkasadoctor,eventuallytrainingasaradiologyregistrarinStoke-on-Trent.DuringthistimehespentsixmonthsinMunich,Germany,inMRimagingand1yearinOswestryasamusculoskeletalfellow.HetookajobasMSKRadiologistinOswestryandhasdevelopedininterestincartilageimagingandspinalimagingandintervention.

Dr David WilsonConsultant Interventional MSK Radiologist, Oxford University Hospitals NHS Trust and President, BIR

DrWilson’sprimaryinterestisintheapplicationofmodernimagingtechniquestodisordersofthelocomotorsystemandspineintervention.Hehasundertakenoriginalworkintheapplicationofdiagnosticultrasoundtojoint,muscle,andsofttissuediseasewithparticularattentiontojointeffusionandcongenitaldysplasiaofthehip.Hehasover20yearsofexperienceinvertebroplastyandistheauthorofpublicationsonmulticentrecontrolledtrialsonthetreatmentofinsufficiencyfractures.HehasestablishedinnovativetrainingcoursesintheUKinmusculoskeletalultrasoundinOxfordandBath.Heteachesinternationallyandisaleaderinthedevelopmentofultrasoundinmusculoskeletaldiseaseandinjectiontechniquesinthespine.HehasconsiderableexperienceinallaspectsofmusculoskeletalimagingandistheEditoroftheprincipletextbookonMSKimaging.AsaformerPresidentoftheBritishSocietyofSkeletalRadiologistandapreviousMedicalDirectoroftheNuffieldOrthopaedicCentrehehaswideclinicalandresearchexperience.HehasbeenamemberoftheBIRsince1982.HewasCommissioningEditoroftheBJR(2011-12)andthenDeputyEditor(2012-2013).HewasVicePresident(ExternalAffairs)from2012-2014.HeiscurrentlyPresidentoftheBIR(2014-16).

Dr Peter WrightPrincipal MRI Physicist, Sheffield Teaching Hospitals NHS Foundation Trust

AfterbeingawardedaPhDinMRIPhysicsattheUniversityofNottingham,DrWrightstartedtrainingtowardsbecomingaclinicalscientistattheUniversityHospitalNorthStaffordshire(UHNS).DrWrightcontinuedhistrainingatLeedsTeachingHospital,wherehewasresidentMRIPhysicisttotheNIHRLeedsMusculoskeletalandBiomedicalResearchUnit(LMBRU)for3years.Sincethen,DrWrightreturnedtoUHNStoestablishanddevelopanMRPhysicsteamandisnowPrincipalMRIPhysicistatSheffieldTeachingHospitalsNHSFoundationTrust.

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Lecture A - a scientific lecture to cover the physics aspects of the subsequent lecturesDr Peter Wright

Educationaims• Introductiontofatsaturationtechniques• AdvantagesanddisadvantagesofSTIR,SPIRandSPAIR• Importanceofshimming• Tipsandtrickstoreduceartefactcausedbymetalimplants• Tounderstandthephysicsbehindthemagicangleeffect

Bytheendofthelecturedelegatesshouldbefamiliarwithfatsuppressiontechniques,includingshorttauinversionrecovery(STIR),spectralpre-saturationwithinversionrecovery(SPIR)andspectraladiabaticinversionrecovery(SPAIR)andtheadvantagesanddisadvantagesofthesetechniques.Theroleofshimmingwillbeintroducedandtheimportanceitplaysinfatsuppression.

MetalimplantscancausesevereartefactinMRimagingtothepointthatimagescanbenon-diagnostic.ThesecondpartofthelecturewilldiscusstipsandtrickstoreducingmetalartefactusingmodifiedstandardMRsequences.

ThemagicangleeffectcancausetheT2oftissuestolengthen.InthecaseoftendonsandothershortT2tissuesthiscanresultinsignalappearingwherenoneisexpected,leadingtothepotentialformis-diagnosis.Herewewilllookatthephysicsbehindthemagicangleeffectandhowtoidentifyit.

Lecture B - CartilageDr Bernhard Tins

Cartilagedamageduetotraumaordegenerationisacauseforjointdegeneration.Thisisassociatedwithpain,lifestylelimitationsandmorbidityandultimatelycost.Theinterestincartilageimaginghasarisenfromtheneedtobetterunderstanddegenerativejointdisease.

Cartilagehasacomplexmicroscopicstructure.Innormalcartilageitsnutritionispurelybydiffusionanditsmetabolicrateandrepaircapacityisthereforelimited.Thenormalanatomyandimagingappearanceofcartilagewillbediscussed.Inrecentyearsimagingtechniqueshavebeendevelopedthatallowtoassesscartilagemetabolismandinfersomeinformationonitsmicrostructure.Conventionalandadvancedimagingtechniquesandtheirrelevancetoroutinepracticeandresearchwillbereviewed.ThisincludescontrastmediumenhancementandT1rhoandT2weightedimaging.

Scoringsystemsforjointdegenerationaresometimesusedbysurgeonsbutaremainlyrelevantforresearch,theywillbrieflybeintroduced.

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Cartilagehasalimitedrepaircapacity.Surgicalrepairtechniques,theirproblemsandcomplicationsandtherelevantimagingappearanceswillbediscussed.Inparticularmicrofracture,chondrocyteimplantationandmosaicplastywillbeexplainedandtheimagingappearancesoutlined.

Whileanumberoftopicswillbecovered,themainaimofthispresentationistoenableageneralradiologisttounderstandwhichaspectsofcartilageimagingarerelevantforroutinepracticeandwhichareasaremainlythedomainsofresearch.Afterthispresentationaradiologistshouldbeabletounderstandtheirorthopaedicsurgeonsandofferguidancetoourorthopaediccolleagues.

Lecture C - Bone Dr David Wilson

Bonesmaybeaffectedbydiseasethatis:-• Lytic• Sclerotic• Mixedlyticandsclerotic• Periostealreaction• Expanded• Deformed• Fractured

Diseasesmaybegroupedas:-• Congenital• Trauma• Infection• Malignant• Metabolic

Imagingisinorderofuse:-• ConventionalRadiographs• CT• MRI• Nuclearmedicine• Ultrasound(thesemethodsarecomplimentary–MRisnotthepanacea)

Commonpitfallsare:-• Missthelyticlesion• Missthediffusemarrowdisease• Misstheperiostealreaction• Misstheundisplacedfracture• Missthesubperiostealerosion• Confuseinsufficiencyfracturewithmalignancy• Forgettothinkofinfection.

Examplesoftheabovewillbepresentedinaquizformat.

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Lecture D - Soft tissue tumoursDr Geoff Hide

ThispresentationwillfocusontheuseofMRIandotherimagingmodalitiesinthediagnosisandstagingofsofttissuetumours.Asystematicapproachtodeterminingadiagnosis,wherepossible,willbediscussedaswilltheadvantagesandlimitationsofMRI.

Lecture E - SpineDr Winston Rennie

Educationalaims:• TounderstandtheprinciplesofspineMRandtheessentialnuancesand

criticaldifferencetoallotherradiologicalimaging-whyspineMRisleftatthebottomofthepile!

• Toplananimagingprotocoltodeliverasmoothpatientthroughputyetnotcompromiseondiagnosticimagequality-quantitynotattheexpenseofquality!

• Todevelopstandardisedclinicallyrelevantnomenclatureandappreciatethediagnosticprocess-stopthetowerofbabel!

• Togainaninsightintospecialisedspineimagingpathwaystailoredtotheclinicalpathology-clinicalstandardisedprotocolsnotstandardprotocols

Learningoutcomes:• Tobeabletoconstructaprotocol/pathwayforspineMRI• Tohaveastandardisedapproachtospinereporting• TobeabletostreamlineservicesandpatientflowthroughtheMR

department• TogainaninsightintoSpAMRIImaging.

Lecture F - Rib lesionsDr Sarah Burnett

Thetalkwillcoverdiverseaspectsofribpathology.LearningoutcomesincludethebenefitsandlimitationsofMRIasamethodofdiagnosingrib,sternalandchestwallpathology.Bytheendofthesession,delegatesshouldexpecttoknowthebestmethodtoimagecertaintypesofribpathology,andlearnsomeoftheclassicalappearances.Thesewillberevisedintheinteractiveandpanelsessions.

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FORTHCOMING EVENTS

WELSH BRANCH MEETING: TO REPORT OR NOT TO REPORT....WHAT IS THE ANSWER?11 NOVEMBER 2014

SOUTH WALES

THE JOURNEY FROM RESEARCH TO PUBLICATION20 NOVEMBER 2014

LONDON

THE FUTURE OF RADIOLOGY IN THE NHS: TOP TOPICS FOR INTERVIEWS21 NOVEMBER 2014

LONDON

DIAGNOSTIC RADIOLOGY FOR ADVANCED HEAD AND NECK CANCER PLANNING26 NOVEMBER 2014

LONDON

STATE OF THE ART RADIOTHERAPY EDUCATION DAY 10 DECEMBER 2014

LONDON

WESSEX BRANCH EVENT 10 DECEMBER 2014

SOUTHAMPTON

ADVANCES IN RADIOTHERAPY FOR PROSTATE CANCER: FROM THEORY TO PRACTICE12 DECEMBER 2014

CARDIFF

THE SPINE IN HEALTH AND DISEASE21 JANUARY 2015

LONDON

CONTRAST STUDY DAY AND ESSENTIAL PHYSICS FOR FRCR29 - 30 JANUARY 2015

SHEFFIELD

RADIOLOGY ERRORS6 FEBRUARY 2015

LONDON

EMERGENCY INTERVENTIONAL RADIOLOGY13 FEBRUARY 2015

LONDON

4TH ANNUAL SPECT/CT SYMPOSIUM: CURRENT STATUS AND FUTURE DIRECTIONS OF SPECT/CT IMAGING23 FEBRUARY 2015

LONDON

THE TECHNOLOGY AND USES OF ON-TREATMENT IMAGING IN RADIOTHERAPY24 MARCH 2015

LONDON

RELATIVE BIOLOGICAL EFFECT IN RADIOTHERAPY14-15 APRIL 2015

OXFORD

VISIT: WWW.BIR.ORG.UK FOR MORE INFORMATION AND TO REGISTER!

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